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Author Topic: Emory Dialysis Clinics in Atlanta Part 2 - UPDATE  (Read 5142 times)
noahvale
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« on: July 31, 2010, 12:07:51 AM »

I was going to respond to a previous topic about the new Emory Clinics in Atlanta.  However, since it was started over 120 days ago, forum administrators suggested that I start a new one.  So here goes...

I recently transferred to Emory Dialysis/Northside.  My former clinic (a story for another day) is less than 7 minutes from home, yet I am more than willing to travel the extra 30-45 minutes to receive, what I believe to be the best dialysis experience in Atlanta.  I base this on 18+ years as a dialysis patient.

First of all, Emory Healthcare OWNS all of its clinics and Emory nephrologists make all the medical decisions and set the standards of care.  It has a contract with a company out of Tifton, GA - Health Systems Management - to staff and run the day to day operations of the facilities.  Emory chose HSM based on physician/staff visits to 15 dialysis centers operated by them for Wake Forest University, which has the largest academic outpatient dialysis program in the U.S.

Emory/Northside is a large facility with home training programs and 38 inpatient stations (including 2 for isolation) with 8 stations in five different bays (A-E).  At this time it only runs 2 shifts on Mon-Sat. with the last patients coming off treatment around 4 p.m. 

Georgia law requires 1 PCT (patient care technician) for every 4 patients, so there is a minimum of 2 techs per Bay.  Georgia law also requires one RN on the floor at all times and an RN/LPN for every 10 patients.  Since I have been at Emory Northside it has either met or surpassed these requirements. 

While the room is HUGE, it is planned out really well and the nurses can see just about the whole area from their station.  One would think a place this big would have horrible acoustics - not so.  It is really quiet for being so large.

Patient care is the top priority at this center.  The doctors round daily, and the social worker and dietitian are there every day and seem to be accessible if you need something. 

The machines are all new Fresenius 2008k's and have poles with red lights so staff can see from just about anywhere in the treatment area whose alarm is going off.  However, two of the first things I noticed at this clinic were how few times patient alarms do go off and how quickly a staff member responds when it does happen.  At my former clinic pt. machine alarms were always going off.   Staff members could be standing right next to a machine with an alarm going off - with even the blood pump stopped - and be oblivious to it or just walk on by because "it wasn't their patient."

There is no dialyzer reuse - at all - and they have 3 different (maybe more) size dialyzers to choose from for your dialysis prescription.  Something else that I noticed never done at any other facility - once you are on the machine, the PCT places a plastic cover over your dialyzer and dialysate line connections.  This is to keep any airborne contamination from one patient to another.  A nice detail.

More on the staff.  To me, the most important person in a dialysis center is the facility or nurse administrator.  This person has to make sure the floor staff is following all infection control procedures (especially properly wiping down machines and chairs between patients) and to insure patients receive the best possible care (including not unnecessarily cutting treatment times).  Again, from my limited time in this clinic and what I can view from the chair in my Bay,  the floor staff is doing what they are supposed to be doing.  They act professional, yet are friendly.

I will say that 5 of the staff from this clinic - the nurse administrator, 1 charge nurse, 1 floor nurse (both RNs) and 2 PCTs came from my former clinic.  A couple of them I had reservations about, but decided that they would do well in a system that would not put up with nonsense.  And, I believe this is the case with Emory Northside.  From my understanding, HSM (the company that runs the day to day operations) has let staff go for not meeting certain expectations.  But, from talking with the staff members that I know, they all seem really, really happy here.  That's a plus because then there is usually less staff turnover.  In the Atlanta area there is a shortage of experienced, well-trained dialysis personnel. 

There is a possible downside to coming here or to one of the other Emory Dialysis Clinics, you must be a patient of one of the Emory nephrologists (exception would be receiving treatment as a transient patient).  At this time, they do not give privileges to outside nephrologists.  However, Emory Healthcare has 10 nephrologists on staff to choose from.  This is something I had to consider when coming here, but in a different way. 

My nephrologist went from a private practice to Emory, but in the renal/pancreas transplant department of medicine.  This meant he would no longer be seeing current dialysis patients.  So I interviewed with one of the nephrologists he suggested and felt we would be a good match.  My former nephrologist will still see me monthly for a while until I'm comfortable with my new doctor and center.

What else can I tell you?  There is a nice waiting room with a flat panel TV and free coffee.  Patient chairs are oversized and comfortable, each station has its own flat screen TV with remote and earpiece and the temperature in the treatment area is quite comfortable (my old clinic was freezing year 'round).  No eating on the machine unless you are a diabetic and need to watch blood sugar.  One of the forms I received stated that visitors could come in for 15 minutes at a time except when patients are being put on or taken off the machine.  So far though, I haven't seen anybody with visitors. 

They do not give hypertonic saline for low BP or cramping, but do use mannitol (which I find interesting).  You can self-cannulate, but not sure about total self-care (I do set up my machine).

The Emory Northside facility is located at 610 Northside Dr. about a block from the intersection of Northside Dr. and North Ave., just behind the Georgia Tech campus.  It is on the #99 MARTA bus line (North Ave./Bankhead Train Stations), but it only comes by in both directions once an hour.  You can also take the #27 bus (North Ave. Station), but that would require about a 3-4 block walk while the #99 stops in front of (or across the street from) the clinic. 

Please feel free to ask me any questions.  I'll probably add new threads as time goes on to give updates on how it is going.  If you are interested in this clinic by all means contact "T," the nurse administrator; Ketia, the floor charge nurse; or Louise, the facility social worker to arrange a tour.  The phone number is 404.778.1050. 

Also, something I just recently found out, we can dialyze as transient patients in a different clinic in the same city/area for a week without having to transfer, just to see if we really do want to make a switch.  It's like a trial period and Medicare will pay for it.  Hope this helps.




« Last Edit: March 09, 2011, 10:30:38 PM by noahvale » Logged

"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
Rerun
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« Reply #1 on: July 31, 2010, 07:21:34 AM »

Yes, but do you have an ice machine?   ???

You should be able to have visitors.  How would family think about giving you a transplant if they don't see you on the machine and the needles being jammed into your arm. 

You should be able to have a snack and a drink by your chair.  The free coffee part is nice as long as you can take it into the treatment room.

And a personal TV with cable and a DVD player.

Otherwise you have a perfect clinic.   ;D

OH.... and a locker for all my crap!
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Zach
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« Reply #2 on: July 31, 2010, 09:20:22 AM »

noavale,

This is a perfect example of patient choice and I thank you for your post.
Please keep us informed as you continue on your hemodialysis journey!

8)
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In-center uninterrupted hemodialysis since 1982--32 YEARS on March 3, 2014 !!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
No transplant.  Not yet, anyway.  Only decided to be listed on 11/9/06    ;)
Work full time.  I make films.

Just the facts: 75 kgs. (about 165 lbs.)
Treatment: Tue-Thur-Sat   5 hours, 2x/wk, 6 hours, 1x/wk
600 dialysate flow (Qd)  ~400 blood pump (Qb)
Fresenius Optiflux-180 filter--without reuse
Fresenius 2008T dialysis machine
My KDOQI (+/ -):  2,625 Calories, 90 grams Protein per day.

"Living a life, not an apology."
noahvale
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« Reply #3 on: July 31, 2010, 05:55:34 PM »

noavale,

This is a perfect example of patient choice and I thank you for your post.
Please keep us informed as you continue on your hemodialysis journey!

8)

Unfortunately, in Atlanta, the "choices" for finding a quality dialysis clinic are minimal considering DaVita and Fresenius control about 70% of the market while the majority of the rest are divvied up among providers who have the same mindset as the two big boys.  But, I understand where you are coming from.  (-:
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"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
noahvale
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« Reply #4 on: July 31, 2010, 06:13:49 PM »

Yes, but do you have an ice machine?   ???

You should be able to have visitors.  How would family think about giving you a transplant if they don't see you on the machine and the needles being jammed into your arm. 

You should be able to have a snack and a drink by your chair.  The free coffee part is nice as long as you can take it into the treatment room.

And a personal TV with cable and a DVD player.

Otherwise you have a perfect clinic.   ;D

OH.... and a locker for all my crap!

You'd have a good time here.
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"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
Stacy Without An E
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« Reply #5 on: August 20, 2010, 12:13:20 PM »

The stories about well run Dialysis clinics are so few and far between, its nice to hear a positive experience for a change.

The one thing I would love at my Dialysis clinic is a personal bubble for each chair.  That way, once I was put on the machine, the bubble could be closed so I wouldn't have to see, hear, smell all the fabulously awful patients in my clinic.
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Stacy Without An E

1st Kidney Transplant: May 1983
2nd Kidney Transplant: January 1996
3rd Kidney Transplant: Any day now.

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Dialysis.  Two needles.  One machine.  No compassion.
noahvale
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« Reply #6 on: March 09, 2011, 10:29:39 PM »

I've now been at the clinic for 7+ months.  While the honeymoon has been over for a while, I still feel making the move was a good choice and that Emory Northside provides the best care in the Atlanta area.  I failed to mention in my first post that the center also trains patients for all PD modalities and NxStage.

There have been a couple of times where I felt it was best to bypass the FA and directly contact the regional director for HSM (contracted by Emory Healthcare to staff and operate the center) to voice my concerns.  She always responded back in an acceptable time frame, appreciated my feedback and also addressed with staff what I brought to her attention.  Really can't ask for much more than that. 

While I personally like both the FA and charge nurse, my confidence in them is somewhat jaded.  They were both at my former DaVita Clinic and I saw how they would bury some of the questionable policies/actions at the facility.  But, as time goes on, my confidence in them is growing, mainly because I see that HSM (and more importantly, the Emory nephrologists who oversee patient care) expects patient care accountability, unlike DaVita.  Some people thrive in a good environment and that's how I'm cautiously beginning to see these two staffers.

The good news is, thanks to my dialysis nephrologist, the center will be opening a nocturnal shift within the next couple of months.  This is HSM's first foray into nocturnal and I'm not quite sure yet that they are 100% behind it, mainly for financial concerns.  However, 5 of us have agreed to be the starting guinea pigs.  If it goes well, word will spread quickly and I foresee a doubling within a couple of months. 

I did my research (thanks in part to IHD) to see what makes for a good incenter nocturnal program, and to why patients become burned out/disenchanted with the modality and return to conventional in-center.  I emailed my concerns and ideas that would make for a successful program to the regional director and my nephrologist.  Plus, I have been talking with the FA to help her understand what nocturnal is all about.  Gave her suggestions on how best to utilize staff members time (which I'm sure HSM has already thought about).  Even gave her a copy of the Scribner/Oreopoulos position paper on HDP.

It seems that most of my suggestions were taken seriously.  While not offering nocturnal 6 days a week, they did agree that T-Th-Sun was the better shift option to allow for less disruptive weekends.  I also believe the time will be from 9 p.m. until 5 a.m.  I explained by having hours from 8 p.m.-4 a.m. as too early to come in and defeats the purpose because many patients end up going back to sleep when getting home.  Also, patient transport services and MARTA Mobility (disability van service provided by the transit system) do not begin before 5:30 a.m. 

Seems that HSM wants us to use current dialysis chairs and not invest in beds or nocturnal chairs.  They're well-padded and comfortable, but don't know about them for 7-8 hours.  I gave the FA links to about 5 nocturnal chair manufacturers and hopefully, management will look into them.  One potential patient has already stated he wants a bed.  I would hope everyone would be willing to use the current chairs at first before deciding.

HSM and the FA all agree that a quiet, non-disruptive environment will be expected on the night shift - from both staff and patients.  They also understand that this is not the day shift or a social event and people need to sleep!  Lights will be turned down after a couple of hours and BP's taken once an hour unless otherwise indicated.  Initially, staffing will include an RN and two techs (state law requires 1 RN at all times and 1 tech for every 4 patients.  DaVita always got around this by splitting an LPN's time between nursing responsibilities and tech duties).

So we'll see.  I'm looking forward to giving it a go.  Next update will be on how it is going.




« Last Edit: March 09, 2011, 10:41:01 PM by noahvale » Logged

"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
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« Reply #7 on: March 09, 2011, 11:07:58 PM »

That's outstanding!  I can't wait to hear about your clinic's very successful foray into nocturnal.  I'm really pleased that you had so much input; we need as much patient input as possible.

I wish ALL clinics could be more like yours.  What can we do as patients to make that happen?
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noahvale
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« Reply #8 on: March 10, 2011, 09:20:20 AM »


I wish ALL clinics could be more like yours.  What can we do as patients to make that happen?

I take very little credit in this center being more patient oriented than the average facility.  It has more to do with Emory nephrologists being fed up with the delivery of care that existed in the Atlanta area and lobbying very hard for Emory Healthcare to open their own cl incs where they would be making patient care decisions.  They looked long and hard before contracting with HSM to oversee the day to day operations.  I am cautiously optimistic that they will remain receptive.  It helps that HSM is not beholden to stock holders so there is a bit more wiggle room on profit margins.  This company also manages all outpatient dialysis for Wake Forest Medical Center's 1500+ patients.

My only influence stems from the fact that Emory and HSM knew beforehand of my reputation as a patient advocate for many years.  I'm fearless in taking on a facility when necessary by contacting the Network and calling in state surveyors.  It also helps that I am knowledgeable about my illness, take good care of myself and have nephrologists who are supportive.  And that's the key - having supportive nephrologists.  The vast majority of nephrologists/medical directors in the for profit facility environment have been bought off and are willing to compromise patient care.

While Emory Northside is an oasis in Atlanta's desert,  I have know doubts that it could dry up at anytime.  It is an urban clinic with a 97%+ under educated, economically lacking, black in-center patient population, with the vast majority having only medicare or medicaid insurance.  I'm sure Emory is eating a lot in reimbursement, not HSM.
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"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
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« Reply #9 on: March 11, 2011, 07:11:12 PM »

We have a family friend that works for Emory dialysis.   He has his undergraduate degree is from Emory and his father is a nephrologist.   I imagine Emory attracts educated workers and that would drastically improve the in center experience. 

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Girl meets boy with transplant, falls in love and then micromanages her way through the transplant and dialysis industry. Three years, two transplant centers and one NxStage machine later, boy gets a kidney at Johns Hopkins through a paired exchange two months after evaluation.  Donated kidney in June and went back to work after ten days.
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« Reply #10 on: March 20, 2011, 07:05:13 PM »

By chance, I ended up at this clinic. My doctor in an EHS Neph, and I've a long history with Emory University...but the truth is that we choice it, from my hospital bed, because my girlfriend works in the Aerospace building a block down the street, and we live over at 10th and Piedmont, so just 2 miles away.

I'm very glad to hear your great reviews. I have had a very positive experience so far. Lots of attention and information when I needed it, and plenty of privacy to be alone with netflix and my machine when I wanted it. I'm on second shift TTS, and go in for my 9th time dialyzing this next week.

Thanks for speaking up noahvale.
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Diagnosed ESRD March 2, 2011
Tunnel Cath Installation March 3, 2011
Begin Hemodialysis March 3, 2011
BigRed
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« Reply #11 on: March 20, 2011, 07:09:52 PM »

I will say that I have only been there, or anywhere, for two weeks. So my experience is extremely limited.
The only complaint I have right now is that the Emory wifi is a bit weak and is sometimes troublesome
for streaming video. But, thats hardly a real complaint.
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Diagnosed ESRD March 2, 2011
Tunnel Cath Installation March 3, 2011
Begin Hemodialysis March 3, 2011
noahvale
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« Reply #12 on: March 22, 2011, 08:47:02 AM »

I imagine Emory attracts educated workers and that would drastically improve the in center experience.

Depends on your definition of "educated workers."  Patient Care Techs (PCTs), the staff members who have the majority of interaction with patients, are entry level positions at a center.   Because of the expansion of dialysis services, the demand for experienced PCTs far outweighs the supply. 

Many of the PCTs in facilities have less than 2 years experience within the field, while a significant percentage less than 6 months - especially in the larger urban areas of the country.  Their "education" was graduating from a medical mill tech program.  Fortunately, federal law enacted in 2008 now requires PCTs to be certified under a state certification program or a national commercially available certification program [Board of Nephrology Examiners Nursing and Technology (BONENT) or National Nephrology Certification Organization (NNCO)]. 

Newly employed patient care technicians must be certified within 18 months of being hired as a dialysis patient care technician.  For patient care technicians employed on or before October 14, 2008, they must have been certified by April, 2010.

This requirement should help with the hands on component of patient care.  However, the majority of providers will always find ways to maximize profits while meeting the bare minimum in standards of care, basically on the backs of their in-center patients.

I would suggest that in center patients (U.S.) check with their clinics to see if the PCTs are in compliance with the applicable 2008 ESRD Rules and Regulations.


« Last Edit: March 22, 2011, 08:48:17 AM by noahvale » Logged

"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
noahvale
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« Reply #13 on: March 22, 2011, 08:57:33 AM »

By chance, I ended up at this clinic. My doctor in an EHS Neph, and I've a long history with Emory University...but the truth is that we choice it, from my hospital bed, because my girlfriend works in the Aerospace building a block down the street, and we live over at 10th and Piedmont, so just 2 miles away.

I'm very glad to hear your great reviews. I have had a very positive experience so far. Lots of attention and information when I needed it, and plenty of privacy to be alone with netflix and my machine when I wanted it. I'm on second shift TTS, and go in for my 9th time dialyzing this next week.

Thanks for speaking up noahvale.


I'm glad your transition in going well.
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"Happiness isn't based on absence of conflict, but in one's ability to cope with it."

03/1978 - Started In-Center Hemo
06/1990 - Cadaver Transplant - UAB
03/2003 - Transplant Rejection
06/2004 - In-Center Hemo
07/2005 - Relisted at UAB
04/2011 - In-Center Sun-Tues-Thurs Nights/Extended Hours
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